NCLEX= LAB VALUES

The nurse is reviewing the laboratory studies of a client receiving epoetin alfa. When should the nurse expect to note a therapeutic effect of this medication on the hemoglobin and hematocrit?

2 MONTHS AFTER THERAPY

A hospitalized client with heart disease who is taking digoxin has a digoxin level prescribed. The level is elevated above normal. Based on this finding the nurse plans to notify the registered nurse and primary health care provider (PHCP) and anticipates which additional interventions will be prescribed? Select all that apply.

1.Monitor the potassium level. 2.Place the client on cardiac monitor. 5.Monitor the blood urea nitrogen (BUN) and creatinine.

The nurse is assisting in monitoring a client who may be started on parenteral nutrition (PN). The nurse reviews the client's laboratory results and determines that the client is at risk of severe malnutrition if the albumin level report indicates which critical level?

2.8 g/dLRationale:The serum albumin level is a critical indicator of the need for PN. The client whose albumin level is 2.8 g/dL is at severe risk for malnutrition. The normal serum albumin level in the adult is 3.4 to 5 g/dL.

A primary health care provider is caring for a client who is human immunodeficiency virus (HIV) positive and has delivered a newborn baby. The nurse anticipates which interventions should be employed for the newborn to decrease the risk of HIV. Select all that apply.

2.HIV testing of the newborn within 48 hours 4.Antiretroviral prophylaxis for newborns testing HIV positive. 5.Periodic testing for HIV at set intervals until the age of 6 months.

The nurse is assigned to a hospitalized client with chronic pancreatitis. The nurse reviews the client's record and expects to note a serum amylase level that is most like which value?

25 UNITS/L Rationale:Chronic pancreatitis is inflammation of the pancreas that occurs long term. It is a progressive destructive disease and is often caused by alcoholism or chronic biliary tract disease including cholecystitis and cholelithiasis. The normal serum amylase level is 25 to 151 units/L. In chronic cases of pancreatitis, the rise in the serum amylase level usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Client Needs: Physiological IntegrityCognitive Ability: AnalyzingContent Area: Fundamentals of Care: Laboratory ValuesIntegrated Process: Nursing Process/Data CollectionPriority Concepts: Inflammation, PainStrategy(ies): Strategic Words, Subject

The nurse is caring for a client recovering from hepatitis. The nurse recognizes the need to report which laboratory test result to the primary health care provider?

Alanine aminotransferase (ALT) that is significantly elevated As tissues in the body are injured, enzymes present in the cells are released and can be monitored through blood tests. It is important to recognize which enzymes are found in which tissues. ALT is found predominantly in the liver, and an elevated level would indicate significant liver damage. The WBC count may be slightly elevated with the hepatitis.

A child is receiving edetate calcium disodium (calcium EDTA) for the treatment of lead poisoning. Which laboratory result would be important to monitor during treatment?

BUN LEVEL

A child is receiving edetate calcium disodium (calcium EDTA) for the treatment of lead poisoning. Which laboratory result would be important to monitor during treatment?

Blood urea nitrogen (BUN) levelRationale:An adverse effect of edetate calcium disodium is nephrotoxicity. Urine flow and the BUN are assessed before the start of therapy.

Which laboratory result would verify the diagnosis of bacterial meningitis?

Cloudy cerebrospinal fluid with high protein and low glucose levels

The nurse working the 3:00 to 11:00 pm shift notes that a client with coronary artery disease (CAD) has a prescription for serum lipid levels to be drawn in the morning. The nurse places the client on which dietary preparation to ensure accurate test results?

Fasting for 12 hours

The nurse is reviewing the complete blood count (CBC) laboratory results of a female adult client suspected of having iron deficiency anemia. The nurse reviews the results and determines that which results are consistent with this diagnosis? Select all that apply.

Hemoglobin (Hgb) 8.8 g/dL Hematocrit (Hct) 30% Decreased mean corpuscular volume (MCV) 66 fL Iron deficiency anemia is a low red blood cell count caused by inadequate iron intake or absorption from the diet or blood loss. The low Hgb and Hct indicate an anemia. The normal hemoglobin level for an adult female is 12 to 16 g/dL, and the normal hematocrit is 37% to 47%. The low MCV (normal 80 to 95 fL) indicates a microcytic anemia (red blood cells smaller than normal), which is consistent with iron deficiency anemia.

A licensed practical nurse (LPN) is assisting in the care of a client receiving a continuous intravenous (IV) infusion of heparin sodium for deep vein thrombosis (DVT). The LPN notes that the result of a newly drawn activated partial thromboplastin time (aPTT) level is 90 seconds. The client's baseline before the initiation of therapy was 30 seconds. The LPN should take which action?

Notify the RN about the value immediately.

A client with a history of seizure disorder is receiving phenytoin in the hospital. The client has a seizure and the nurse reviews the laboratory results of the phenytoin level of 18 mcg/mL. The therapeutic level is 10 to 20 mcg/mL. The nurse understands from reviewing the medication level that which is the correct situation?

Phenytoin alone is not effectively controlling seizures. The therapeutic range for serum phenytoin level is 10 to 20 mcg/mL. The client has been receiving phenytoin in the hospital, and the blood level is within the therapeutic range. The client needs an additional medication or a different medication since the seizures are not controlled with a therapeutic level of phenytoin. There are no data in the question to suggest the client is allergic to phenytoin. The dosage is therapeutic so it should not be increased or decreased.

A client is receiving standard oral anticoagulant therapy with warfarin. The result of a newly drawn international normalized ratio is 3.8 seconds. The client needs to have an invasive procedure done on the next day. Which medication will likely be ordered to reverse the anticoagulant effect?

Phytonadione A client who is prescribed warfarin will need to have the medication reversed if an invasive procedure is planned. Vitamin K1 or phytonadione is administered to reverse warfarin.

The nurse is reading a client's urinalysis report. The nurse interprets which item found on the report to be considered abnormal? Select all that apply.

Positive protein Leukocyte esterase positive White blood cells, 10 per high power screen A urinalysis tests the urine specimen at hand for appearance, concentration, and content and is a broad screening for abnormalities. Presence of protein is abnormal and could indicate a kidney problem. Leukocyte esterase is an enzyme produced by white blood cells and may indicate infection. The number of white blood cells should only by 0 to 2 and a count of 10 could indicate infection. The pH of 6 is normal since urine has a normal pH range of 4.5 to 8. A specific gravity of 1.018 is normal, with normal ranging from 1.010 to 1.025.

The nurse is reviewing the laboratory results from the lumbar puncture performed on a client with a diagnosis of meningitis. Which findings are indicative of a bacterial infection? Select all that apply.

Protein level of 20 mg/dL Increased white blood cells A cerebrospinal fluid (CSF) pressure of 250 mm H2O If a bacterial infection of cerebrospinal fluid is present, test results will indicate a cloudy appearance, pressure greater than 200 mm H2O, protein greater than 15 mg/dL, increased white blood cells, and reduced glucose level. Clear cerebrospinal fluid (CSF) is normal.

A CD4+ count has been prescribed for a child with human immunodeficiency virus (HIV) infection. The mother asks the nurse about the purpose of the test and why the test needs to be done if it is already known that the child has HIV. The nurse should reinforce which information to the mother? Select all that apply.

The CD4+ count is used to determine the child's immune status. The CD4+ count is used to identify the risk for disease progression. The CD4+ count identifies the need for Pneumocystis jiroveci pneumonia prophylaxis after 1 year of age. The CD4+ count is measured at ages 1 and 3 months, every 3 months until the age of 2 years, and at least every 6 months thereafter. More frequent monitoring of CD4+ counts is indicated when pneumonia prophylaxis and antiretroviral therapy are administered.

The nurse caring for a male client with a diagnosis of gastrointestinal (GI) bleeding reviews the client's laboratory results and notes a hematocrit level of 30%. Which action should the nurse take?

Report the abnormally low level.

The nurse caring for a male client with a diagnosis of gastrointestinal (GI) bleeding reviews the client's laboratory results and notes a hematocrit level of 30%. Which action should the nurse take?

Report the abnormally low level.Rationale:The normal hematocrit level in a male client ranges from 39% to 52%, depending on age. A hematocrit level of 30% is a low level and should be reported to the registered nurse and health care provider because it indicates blood loss.

A nurse about to give a daily dose of digoxin and notes that a serum digoxin level drawn earlier in the day measured 2.7 ng/mL. The nurse should take which actions? Select all that apply.

Report the finding to the registered nurse. Gather data from the client related to signs of toxicity.

The nurse is explaining to a client the reason a peak and trough has been prescribed because the client is receiving an antibiotic. Which reason for the blood levels should be included in the teaching plan?

To determine if the dose of the antibiotic is effective against the organism causing the infection Rationale:The peak and trough levels are blood concentrations of the prescribed antibiotic. The peak is the high point of the antibiotic level in the blood and is drawn 30 to 60 minutes after administration of the medication. The trough is the low point of the antibiotic level in the blood and is drawn 30 minutes before the next scheduled dose. The peak and trough level of an antibiotic are prescribed to determine if the dose of the medication is at a level that will kill the pathogen causing the infection. The blood urea nitrogen and creatinine levels are indicative of renal function. A test dose or skin test of a medication could be used in advance to determine if the client is allergic. Most often, observation of symptoms after medication administration is how allergies are determined. Whether a symptom is caused by the medication is not determined by the peak and trough. However, the prescriber can use the levels to see how the dose and frequency are excreted by the body. The goal is to prescribe the smallest dose that is effective.

A client is seen in the urgent care center for complaints of chest pain 2 days ago. Since that time, the client has not been feeling well and fatigues easily. The nurse reviews the results of the laboratory tests. An elevation of which laboratory test indicates a myocardial infarction occurred at the time of chest pain 2 days ago?

Troponin I levels When a myocardial infarction occurs, the heart muscle is damaged and enzymes (cardiac markers) are released into the bloodstream. Laboratory testing can detect elevations to support the diagnosis. Troponin I levels elevate as early as 3 hours after myocardial injury and may remain elevated for 7 to 10 days. The myoglobin level can rise as early as 2 hours after a myocardial infarction, with a rapid decline in the level seen after 7 hours. The CK level begins to rise within 6 hours of muscle damage, peaks at 18 hours, and returns to normal in 2 to 3 days.

A client is admitted to the hospital with a fever and extreme weakness. Which laboratory studies are likely to be elevated if the client is experiencing an infection? Select all that apply.

WBC/ESR

Which cardiovascular sign should the nurse expect to note in a client with a diagnosis of hypocalcemia?

hypotension Cardiovascular manifestations that occur with hypocalcemia include decreased heart rate, diminished peripheral pulses, and hypotension. On the ECG, the nurse should note a prolonged ST segment and a prolonged QT interval.

A client is admitted to the hospital with a diagnosis of malnutrition. The nurse is told that blood will be drawn to determine whether the client has a protein deficiency. Which laboratory data indicate that the client is experiencing a protein deficiency? Select all that apply.

Serum albumin, prealbumin, and transferrin are measures of visceral protein and provide objective data for determining protein deficiency in malnutrition. Albumin reflects protein over the last few weeks and is affected by the fluid status of the client. Normal albumin levels are 3.5 to 5.0 g/dL. Prealbumin is more sensitive and represents more recent protein levels since it has a half-life of 2 days. Normal prealbumin levels are 15 to 36 mg/dL. Serum transferrin is an iron transport protein that can be measured directly or calculated as an indirect measurement of total iron-binding capacity. It is a more sensitive indicator of protein status than albumin. When the serum transferrin level is less than 100 mg/dL, the level of visceral protein depletion is severe.